What Is EMS Revenue Cycle Management?

January 24, 2020

Revenue cycle management is the financial handling of a provider’s business. Through managing the many steps and layers involved in bringing a healthcare service to a billable claim, revenue increases.

EMS providers face unique challenges and require specialized knowledge to ensure maximum revenue effectiveness. Key aspects of the healthcare industry, such as authorizations, specifications for claim requirements and billing regulations are addressed through revenue cycle management.

Utilizing revenue cycle management can optimize the revenue stream, enhance productivity and financial stability by identifying opportunities that are tailored to fit EMS’ unique niche in the healthcare industry.

Revenue cycle management works by handling and overseeing the financial operations of a healthcare provider. The focus of this management is on reducing days between a service being provided and payment being received, increasing revenue as well as addressing and minimizing risk, or loss of revenue.

Just as emergency medical personnel have a specific skillset to treat and care for patients, EMS revenue cycle management personnel have the ability and know-how to code claims, seek and identify insurance information, bill carriers per their unique requirements and address denied claims as needed.

There are key steps involved in revenue cycle management.

  • Integrated Software
    • Information that connects between platforms/systems provides the ability for communication to transmit seamlessly from medical personnel on-scene with a patient to a billing office.
  • Coding
    • Medical coding is complex and ever-changing. Accurately transitioning documentation into a billable claim turns performance/action/work into reimbursement.
  • Denial Management
    • Managing unpaid claims is an often overlooked piece of revenue cycle management. Verifying insurance carriers are accurately processing claims and ensuring there are no lost opportunities for claim payments is critical to successful revenue management.
  • Reporting Methods
    • Accurate reporting is the checks and balances within revenue cycle management. Reporting needs to provide a full-picture view of the business, from outstanding claims to be coded, the A/R that is outstanding and how revenue overall is trending.

Ultimately, revenue cycle management handles the financial aspect of EMS healthcare and allows the provider to focus on the medical care of their patients. Effective revenue cycle management is the next step, after medical personnel have completed their job, in providing thorough patient care.

Accurate billing and following a claim through to resolution benefits providers through increased revenue and financial stability. Patients see effective revenue cycle management as good customer service.